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January 31, 2006HeartOpen Access

Non-invasive coronary flow reserve is correlated with microvascular integrity and myocardial viability after primary angioplasty in acute myocardial infarction

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Why the study?

Does preserved coronary flow reserve (CFR) after primary angioplasty for anterior AMI predict microvascular integrity and myocardial viability?

Population

24 patients with anterior acute myocardial infarction who underwent primary angioplasty in the left anterior…

Comparison

Preserved coronary flow reserve assessed by… vs Impaired coronary flow reserve (CFR < 2.5)

Design

Cohort

Follow-up

3 months

Authors

RMRoberta MontisciCardiac Imaging

Discussion

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Implication

Impaired CFR after anterior AMI angioplasty associates with greater no-reflow; supports CFR as microvascular marker but leaves clinical adoption open.

Key Points

  • To determine whether non-invasive assessment of coronary flow reserve early after reperfused acute myocardial infarction reflects microvascular integrity and predicts subsequent myocardial viability.
  • Assessed coronary flow reserve (CFR) in the left anterior descending artery via transthoracic echocardiography and microvascular perfusion via myocardial contrast echocardiography (MCE) approximately 48 hours after primary angioplasty in N=24 patients with anterior acute myocardial infarction.
  • Conducted low-dose dobutamine echocardiography at a mean of 6 days post-infarction and follow-up transthoracic echocardiography at 3 months to evaluate regional wall motion score index (A-WMSI).
  • Microvascular no-reflow extent was significantly greater in patients with impaired CFR (< 2.5) compared to those with preserved CFR (> 2.5) (55 [35]% vs 11 [25]%, p < 0.001), and MCE reflow was present in 8/12 preserved versus 1/12 impaired CFR patients (p < 0.05).
  • Patients with preserved CFR exhibited improved regional wall motion at dobutamine testing (A-WMSI 1.38 [0.45] vs 1.97 [0.67], p < 0.05) and 3-month follow-up (A-WMSI 1.36 [0.40] vs 1.97 [0.64], p < 0.05) despite similar baseline values (2.14 [0.39] vs 2.32 [0.47], p = NS).
  • Multivariate analysis demonstrated that MCE reflow was the only independent predictor of functional recovery at both dobutamine and 3-month follow-up echocardiography (OR 1.06, 95% CI 1.00 to 1.10, p = 0.009).

Structured PICO

Does preserved coronary flow reserve (CFR) after primary angioplasty for anterior AMI predict microvascular integrity and myocardial viability?

P
Population
24 patients with anterior acute myocardial infarction (AMI) who underwent primary angioplasty in the left anterior descending coronary artery (LAD)
I
Intervention
Preserved coronary flow reserve (CFR > 2.5) assessed by transthoracic echocardiography 48 hours after primary angioplasty
C
Comparator
Impaired coronary flow reserve (CFR < 2.5)
O
Outcome
Microvascular dysfunction ('no-reflow' phenomenon) assessed by myocardial contrast echocardiography (MCE) and myocardial viability assessed by low-dose dobutamine echocardiography and follow-up echocardiography at 3 monthssurrogate

Non-invasive assessment of coronary flow reserve early after reperfused anterior AMI correlates with microvascular integrity and predicts myocardial viability at 3 months.

Cite This Study

Roberta Montisci (2006) studied this question.

synapsesocial.com/papers/6a7f31296cdc9ba79316c1f2https://doi.org/10.1136/hrt.2005.078246
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Coronary flow reserve is reflective of myocardial perfusion status in acute anterior myocardial infarction2000 · 16 citations
  2. 2Coronary blood flow reserve and wall motion recovery in patients undergoing angioplasty for myocardial infarction1999 · 47 citations
  3. 3The “No-Reflow” Phenomenon after Temporary Coronary Occlusion in the Dog1974 · 1,850 citations
  4. 4Low-dose dobutamine echocardiography detects reversible dysfunction after thrombolytic therapy of acute myocardial infarction.1993 · 403 citations
  5. 5Assessment of Myocardial Perfusion by Harmonic Power Doppler Imaging at Rest and During Adenosine Stress2000 · 174 citations